Pictorial evidence from ancient times emphasizes the central importance of scalp and facial hair in presenting a "self" image to one's self and to others. Because we only see the hairstyles of nobles and warriors, we believe that social status and power were symbolized by hair style.

As Western societies became more industrialized and democratic, the style of hair worn is more strongly associated with self-esteem and sexual attraction. The Nineteenth Century French novelist Gustave Flaubert shows us this in his novel "L'Education Sentimentale". His central "middle class" character makes a hair dresser one of his first stops when he moves from his provincial home town to Paris to improve himself in his own eyes and find a wealthy mistress.

In the industrial and post-industrial societies of the 21st Century-epitomized by the United States and Western Europe, facial and scalp hair are primarily sexual symbols and secondarily symbols of social status. As symbols of sexual attraction, they are necessarily symbols of positive self-esteem.

Facial and scalp hair, but especially scalp hair, contribute to an overall body image, the image that one likes to see in the mirror and hopes to project to others. A fact increasingly recognized by physicians and psychologists, hair loss can contribute to disturbance of body image, with resulting loss of self-esteem. The psychological and emotional effects associated with loss of self-esteem can, in some persons, become psychologically disabling anxiety and depression.

In psychologically predisposed persons, even the fear of hair loss may result in clinical symptoms of anxiety and depression. Physicians must carefully evaluate patients who display signs and symptoms of dysmorphophobia-a fear of loss of body image unsupported by any physical evidence of hair loss or other cosmetic deficiency.

Physicians are also more aware today of the necessity to take a patient's hair loss seriously. While some men may take hair loss in stride as a normal phenomenon to be expected in men, others may be less comfortable with this change in appearance. Women are less likely than men to take hair loss as a normal phenomenon, in part, because hair loss is generally considered a genetic condition in males, but that is not normal for women. In either instance, for men or for women, physicians should be sensitive to the importance of hair in a patient's self-esteem, and be willing to counsel a patient on options for hair restoration.